Perception and Attitude of College Students toward Cosmetic Rhinoplasty

Introduction: Rhinoplasty, a surgery that reshapes the nose to increase facial beauty or to restore the nasal function after a physical defect, is the most popular plastic surgery worldwide and second most common in Saudi Arabia. Regardless of how common this procedure is done in Saudi Arabia, there is a huge lack of studies on how medical students feels and acts towards it. Thus, this study aimed to assess the perception and attitude of cosmetic rhinoplasty among Fakeeh college students in Jeddah, Saudi Arabia. Materials and Methods: A validated questionnaire about participants desire to rhinoplasty was randomly distributed among all Fakeeh College students in a simple random technique. Results: 306 participants completed the questionnaire Most responders (60.1%) were happy with their noses. A significant association was noted between gender and desire to undergo rhinoplasty (P=0.034). Also, there is a significant relationship between the participant’s desire for rhinoplasty and its cost (P = 0.034). Conclusion: This study showed although rhinoplasty is socially accepted in Saudi Arabia. there is a low desire in college students toward performing rhinoplasty. Factors like cost of surgery or gender affect people’s willingness to do rhinoplasty.


Introduction
Rhinoplasty is the most popular type of plastic surgery that basically reshapes the nose to increase facial beauty or to restore the nasal function after a physical defect, such as birth disorders, trauma, burns, developmental abnormalities, infections, tumors, preference and self-choice (1,2).
Nose appearance and length can affect selfperception in both genders because the nose is located in the center of the face.
Thus, rhinoplasty is becoming more widely used (3). Rhinoplasty has complications which include as in any surgical procedure, which include complications in anesthesia, unsatisfactory appearance and deformity, septal perforation and hematoma, epistaxis, infection and worsening in nasal functions or in the shape rather than improvement (4,5).
Rhinoplasty is considered the fifth most commonly performed plastic surgery type and the second most common in Saudi Arabia (2). Regardless of how common this procedure is done in Saudi Arabia, studies on how the population feels and acts toward it particularly medical students who are more exposed and knowledge regarding rhinoplasty, are lacking. Thus, this study aimed to assess the perception and attitude of cosmetic rhinoplasty among Fakeeh college students in Jeddah, Saudi Arabia.

Materials and Methods
This study was approved by the Fakeeh College for Medical Sciences (FCMS) committee. A cross sectional study was conducted randomly among Fakeeh College students in Jeddah, Saudi Arabia from.
Fakeeh students in all academic years of four departments (Medicine, MLS, Nursing, and Pharma D) were included, and an electronic selfadministered questionnaire was distributed online from February to June 2022.
The sample size was 292, which was calculated by a Raosoft calculator.
In this study, we used an online questionnaire that was validated, and the following sections were included: First section: -Demographic data: (Gender, age, discipline, academic year) Second section: Attitude of the sample, which included 12 questions: The answers for each question are as follows:

Results
Among the 306 student participants, (247 (80.7%)) were females and (59 (19.3%)) males. Most of the students (298 (97.4%)) were aged 18 -25 years. Most of the students were Medicine (201 (65.7%)) ( Table 1). The percentage of students with a history of previous rhinoplasty was 10.8%. Most of the students feel happy regarding their noses (184 (60.1%)). A total of (123 (40.2%)) chose no when we asked if rhinoplasty is necessary. Ninety-three (30.4%) had a family history of cosmetic intervention. Majority (199 (65.0%)) felt that rhinoplasty is socially accepted in Jeddah (Table 2).  A significant association was noted regarding gender and undergoing cosmetic surgery affecting relationships with a P value = 0.029 (Table 3). A significant association regarding specialty and undergoing cosmetic surgeries if performed for free, with a P value = 0.034 and if it is socially accepted to undergo rhinoplasty in Jeddah with a P value = 0.043 (Table 4).

Discussion
This study aimed to assess the perception and attitude of Fakeeh students towards cosmetic rhinoplasty.
The percentage of students whom practice rhinoplasty is (10.8%)according to the results and a similar result as that of our study was revealed at Al-Nahrain University (10.5%), (6) unlike a study performed at the Massachusetts General Hospital of USA. Among female undergraduate students in a university in the northeast (2.7%), had undergone a cosmetic surgical procedure (7).
Furthermore, a study was done among medical students in Al-Taif University and the results revealed that none of the participants had underwent plastic surgery in general before (8), which could mean a higher awareness of cosmetic procedures among medical students in Massachusetts and Al-Taif University than those in our study and in Al-Nahrain university. Regarding weather a person has a relative or friend who had underwent a rhinoplasty, (30.4%) had a family history of rhinoplasty, and (41.2%) had friends' history of rhinoplasty as a total of (71.6%), quite similar to Al-Nahrain which is (15%) individuals who had a family history of rhinoplasty, and (51%) of friends' history (6). Additionally, a study in Riyadh had a total of (54.1%) participants who had relatives or friends with previous rhinoplasty (9). A very different result in Al-Taif University study revealed only (5.9%) of the participants who had a relative who underwent a cosmetic procedure (8), which might mean the high prevalence and knowledge of this procedure among the participants in our study and those in the studies, however, the opposite is true for Al-Taif study.
Regarding satisfaction (60.1%), of the participants were happy regarding their noses, which was higher than the results of a study performed among high school students in Iran, which was (47%) (4), and (48%) of the participants in Al-Nahrain study were also happy (6), which could explain the maturity of a person when in college as the individual develops higher self-esteem and thinks realistically in our study in Saudi Arabia and Iraq. however, among Iran young students, this could explain that their culture is more evident on the population and in the appearance of people. In addition, the age of the population was studied is younger than that in our study, which explains the developing in maturity that did not provide an extreme level of good self-esteem. The minority of the participants (23.2%) thinks that rhinoplasty is necessary, which is similar to that of Al-Nahrain study (28.5%), and that could be due to the high awareness of rhinoplasty procedures in both populations and the similarity in the cultures of Iraq and our country (6). An opposite to the study was performed among healthcare workers in Nigeria with (65.3%) of the respondents who considered cosmetic surgery necessary. (10) and Regarding the supportiveness to a friend who would undergo a cosmetic surgery, our study had a (49.3%) of the participants in our study agreed to this, which was a little less than the (60.1%) of Nigerian healthcare workers studied (10), which confirms the difference in our culture of ours and that of the Nigerians' in addition to the difference in religion as in Muslim countries, rhinoplasty is discouraged, contrary to other countries whose religion might be different than Islam such as in Nigeria.
The majority of the participants in this study (80.7%) was not embarrassed to undergo cosmetic procedures similar to those of Al-Nahrain study which was (70.5%) (6).
Increased awareness in regarding complications, real indications regarding rhinoplasty, and the idea that it will possibly be the best decision for everyone exists in Saudi Arabia. Regarding acceptability in the country, (40.5%) of the participants in our study think that rhinoplasty is averagely acceptable; however in a Nigeria study, only (30.0%) of the participants think that rhinoplasty is averagely acceptable (10). It might be a bit higher in our study just because our sample was bigger than theirs.
Conversely, a study was done among medical students in Al-Taif University in a city near Jeddah, and (61.8%) of the participants who disagreed that cosmetic surgery is accepted socially (8), which could explain the slightly different culture of Al-Taif City; more strict in their religion. A total of (34.6%) the participants in our study participants would undergo cosmetic surgery if it was performed for free, which was similar to the results of Al-Nahrain study (27.5%) (6).
Furthermore, a study was done among the general population in Riyadh which had a result of (24.8%) (9). The study on the Nigerian healthcare workers has a similar result (20.2%) (10), Which might be due to the idea that the surgery it is not necessary and only a very specific situation is will make their decision worth it, such as rhinoplasty performed for free.
Regarding gender, no significant difference in undergoing rhinoplasty was noticed similar to the results of the Iraq study (6).
Conversely, a significant association was noted in this study regarding gender and weather knowing somebody underwent cosmetic surgery would have an effect on their relationship (p value 0.029)similar to that of Al-Nahrain study, which also had a significant association (p value 0.002 2) (6), and that of the Swami V study (11).

Conclusion
This study aimed to assess the perception and attitude of Fakeeh students towards cosmetic rhinoplasty. the results revealed that the percentage of participants who underwent rhinoplasty was (10.8%), and most students (60.1%) were happy regarding their noses, (40%) disagreed on the necessity of rhinoplasty, approximately (30%) had a family history of rhinoplasty, the majority feel that rhinoplasty is socially accepted in Jeddah, gender had significance toward the effect on the relationship with someone who underwent rhinoplasty with a P value = 0.029. Another significant was found regarding specialty and undergoing cosmetic procedures for free with a P value = 0.034.

Limitation
Our sample size has limited our study in such that we required more males to be included, as females are the majority at Fakeeh College.